Case Manager Third Party
Resume:
ANNE P. ELLIS
adyut1@r.postjobfree.com
INSURANCE SPECIALIST:
LIFE, HEALTH, LONG TERM CARE, DENTAL, DISABILITY, INDIVIDUAL HEALTH, SUBROGATION AND SUPERVISORY EXPERIENCE
PROFESSIONAL
EXPERIENCE
Commonwealth Financial April 2020 - Current
Life Case Manager
Waltham, MA
Perform comprehensive medical review of each case, documenting exam findings and medical history, to assess risk and determine if attending physician statement will be required and responsible for ordering medical requirements: exams, labs, ekgs, stress tests and elder assessments.
• Researched and ordered all APS' and upon receipt reviewed records to ensure accuracy and content.
• Performed comprehensive administrative review of each case, providing proactive feedback to producers, carriers and third-party vendors.
• Prepared and documented all new business, utilizing industry software applications and technology.
DMI 2017-2020
Life Case Manager Hingham,
MA
Perform comprehensive medical review of each case, documenting exam findings and medical history, to assess risk and determine if attending physician statement will be required and responsible for ordering medical requirements: exams, labs, ekgs, stress tests and elder assessments.
• Researched and ordered all APS' and upon receipt reviewed records to ensure accuracy and content.
• Performed comprehensive administrative review of each case, providing proactive feedback to producers, carriers and third-party vendors.
• Prepared and documented all new business, utilizing industry software applications and technology.
Symetra 2014-2017
Sr. BGA ~ New Business Case Manager Waltham,
MA
• Processing new business application to contract issuance. This includes but is not limited to promptly responding to routine and non-routine telephone or e-mail inquiries from field contacts, internal sales and marketing departments and management.
• Once risk assessment has been determined by the underwriter, review file and/or policy record for completeness as it pertains to managing requirements. Upon completeness, issue a contract and mail to field contact.
• Manages requests for case status from the field, sales and new business management and as needed, correspond with case field contact and other insurance carriers to resolve outstanding requirements.
• Responsible for Term and Universal Life approvals, reissues, and issue pay transactions generating appropriate refunds when necessary with designated authority limit for voucher approval.
• Researches, analyzes and solves problems for insureds and/or agencies/brokers regarding the status of new business cases. Provides ongoing agent support via phone/email. Brokers’ Service Marketing Group 2009-2014
Underwriting Case Manager Providence,
RI
• Perform comprehensive medical review of each case, documenting exam findings and medical history, to assess risk and determine if attending physician statement will be required. I referred multiple impairment cases to internal underwriter for evaluation.
• With a proven knowledge of medical terminology and medical record management became responsible for ordering medical requirements: exams, labs, ekgs, stress tests and elder assessments.
• Researched and ordered all APS' and upon receipt reviewed records to ensure accuracy and content.
• Performed comprehensive administrative review of each case, providing proactive feedback to producers, carriers and third-party vendors.
• Prepared and documented all new business, utilizing industry software applications and technology.
Garity Associates Brokerage Inc. 2006-2009
New Business Coordinator Norwell, MA
• Main Point of contact for all new business, to include Life / Disability /Individual Major Medical / Short Term / Health Insurance / International and Travel Insurance.
• Worked closely with agents and serviced agents on all levels.
• Coordinated all new business: ordered medical exams and requirements, reviewed medical history to assess risk and determine if attending physician statement would be required, used illustration software to provide quotes, and processed all agent licensing/contracting.
Atlantic Administrators, Inc. 1991-2006
Medical/Dental /Disability Claims Examiner/Supervisor & Waltham, MA
Subrogation Specialist
• Supervised the daily workflow of Claim examiners and Data entry associates
• Performed initial interviews, all performance reviews, annual reviews and salary recommendations
• Underwrote all medical claims based on Self-funded small group guidelines, pre- existing condition clause and Re Insurer guidelines
• Reviewed and processed Dental and short-term disability according to the plan guidelines and provisions
• Performed audits of Stop Loss claims prior to Re Insurance carrier submission
• Submitted stop Loss claims and followed the claim process through to resolution
• Handled all Subrogation claims and negotiated settlements with Attorneys, Property & Casualty Carriers, Auto carriers, and third-party Liability insurers John Hancock Mutual Life Insurance 1987-1991
Medical /Dental Claims Approver
Reviewed and Processed all Medical and Dental
claims Braintree, MA
EDUCATION
Massasoit Community College
Liberal Arts/Human Services- Continued undergraduate studies Newbury College
Medical terminology, Medical office procedures, Anatomy & Physiology
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